Intraoperative dexamethasone on left atrial function and postoperative atrial fibrillation in cardiac surgical patients

Abstract

Introduction Postoperative new‐onset atrial fibrillation (PNAF) is very common after cardiac surgery. The inflammatory response due to surgery and cardiopulmonary bypass (CPB) may contribute to PNAF by inducing atrial dysfunction [1]. Corticosteroids reduce the inflammatory response and may thus reduce atrial dysfunction and PNAF [2]. The aim of this study was to determine whether dexamethasone protects from left atrial dysfunction and PNAF in cardiac surgical patients. Methods Patients undergoing cardiac surgery were randomized to a single dose of dexamethasone (1 mg/kg) or placebo after inducing anesthesia. Transesophageal echocardiography was performed in patients after CPB. The primary outcome was left atrial total ejection fraction (LA‐TEF) after sternal closure; secondary outcomes included left atrial diameter and PNAF, detected by Holter monitoring. Results Sixty‐two patients were included. Baseline characteristics were well balanced. Postoperative LA‐TEF was 36.4% in the dexamethasone group and 40.2% in the placebo group (P = 0.15) (Figure 1). Secondary echocardiographic outcomes were also insignificant (Table 1). The incidence of PNAF was 30% in the dexamethasone group and 39% in the placebo group (P = 0.47). Conclusion Intraoperative high‐dose dexamethasone did not have any protective effect on postoperative LA‐TEF or dimension and did not reduce the risk of PNAF in cardiac surgical patients. (Figure presented).